ENG-1973 — Page 124

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Communicable Diseases

HEALTH

Cholera has not been reported in Hong Kong since 1969. Routine sampling of nightsoil for cholera vibrios was carried out on a year-round basis as part of the surveillance programme. Following a decision of the World Health Assembly cholera vaccination certificates will not be required by an international traveller entering Hong Kong after January 1, 1974.

Tuberculosis remains Hong Kong's principal community health problem. It is believed from figures available that approximately 0.8 per cent of the population is suffering from active pulmonary tuberculosis requiring treatment. Males are affected at least twice as commonly as females, the disease being common in elderly men, while drug addicts are also prone. Tuberculosis in the young is now relatively uncommon and the once large numbers of acute and often fatal cases of tuberculosis in infants are no longer seen.

The government, either by subvention or directly through the Government Chest Service, spends more than $29 million annually on control measures. The tuberculosis control programme is a combined effort between the Government Chest Service, the Hong Kong Anti-Tuberculosis and Thoracic Diseases Association, and the Junk Bay Medical Relief Council; while certain other organisations, including the Tung Wah Group and the Caritas Medical Centre also provide treatment facilities with the aid of substantial government subventions. The Government Chest Service operates seven full-time clinics. There are 13 subsidiary centres throughout Hong Kong.

The Chest Service maintains an extensive Bacille Calmette-Guerin (BCG) vac- cination programme and during the year 97 per cent of babies born in Hong Kong received BCG vaccination within 72 hours of birth. It is believed that the widespread use of this prophylactic measure has led to the rapid fall in tuberculosis in young people in Hong Kong. There are several lines of investigation proceeding with BCG. The investigation of the different techniques of giving BCG to newborn infants showed that the simple triangular needle technique gave satisfactory results. Investigations into direct BCG, advocated for some countries, showed it is not applicable to Hong Kong. The intensive survey of children born after July 1, 1966 notified as suffering or dying from tuberculosis is proceeding smoothly. An investigation into the bifur- cated needle technique of giving BCG has been started.

The cornerstone of treatment is ambulatory chemotherapy on an outpatient basis. The position with regard to the treatment of tuberculosis in the last 15 years has changed completely, and the disease can now nearly always be cured, provided the patient is co-operative and takes treatment regularly. The previous monthly issue of PAS/Isoniazid tablets has now, in a large proportion of cases, been replaced by a regimen of twice weekly Streptomycin injections and high dosage Isoniazid tablets. This has the advantage of being a completely supervised regimen, while it is known that some patients did not take their drugs regularly when issued on a monthly basis.

Large scale co-operation with the Medical Research Council of the United Kingdom continued. The majority of new patients are treated on an outpatient basis and it is also now possible to treat at least a proportion of drug resistant cases-